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Council includes service users when choosing care providers

In Oxfordshire, people who use supported accommodation and their families sit on panels to select who delivers their care.

Brian and Rose Connolly cared for their daughter Lynnie, who has Down’s syndrome, until she was 35. But 10 years ago, Lynnie, who’d seen her brother and sister leave home, decided she’d like to be more independent. After being assessed by experts from Oxfordshire county council, the Connollys’ local authority, Lynnie moved into supported living accommodation.

It’s worked out well, says Brian: “She has grown and blossomed and considers herself to be very independent.” Last year, however, they became concerned when they were told the contract to provide Lynnie’s care would be going out to tender. “It’s quite scary,” says Brian, “because her comfort and equilibrium can be disturbed by having the wrong people looking after her.” So when the Connollys were invited to take part in choosing a new provider, they leapt at the chance.

Oxfordshire county council provides supported living accommodation for 220 adults with learning disabilities. The previous provider, Southern Health, was the subject of a damning report by the audit firm Mazars after 18-year-old Connor Sparrowhawk died in one of its specialist units. Last year, the council and the Oxfordshire clinical commissioning group published a new learning disability strategy that recognised that some people with learning disabilities had been failed in the past, and made a commitment to give them “more choice and control over their lives”.

The end of the Southern Health contract to provide supported living services in December 2015 gave the council the opportunity to put this commitment into practice. In September, it wrote to service users and their families and asked whether they would like to be involved in choosing new providers. Of the 60 who responded positively roughly a third were service users, and two-thirds family members. All 58 potential providers were asked to provide easy-read versions so that service users could understand them.

The decision to consult with service users takes place in a difficult financial context: Oxfordshire has been hard hit by cuts to the adult social care budget. But Kate Evans, campaigns and communications coordinator at advocacy group My Life My Choice says that despite the cuts, the council has continued to be supportive of the organisation, providing it with a self-advocacy grant and helping it to set up a radio show. Evans welcomes the consultation: “We think the best people to know what makes good care are the people who receive it.”

Nine panels were held at which service users or family members sat with council officers to discuss and rate the answers given to a set of standard questions by potential providers, the names of which were kept from the panel. Kate Terroni, deputy director, joint commissioning at Oxfordshire, says: “In every instance the service user or family representative had a larger number of votes than council officers, so we’re placing the emphasis on the importance of the service user and their family in making this decision.”

Mindful that not all service users would have the confidence to express their views in a panel meeting, the council held 15 meetings with smaller groups of service users, where they were able to give their views more informally, and these were fed back into the formal process.

At the panel attended by the Connollys, each member was asked to score the answers given by four providers bidding for the bundle that included Lynnie’s care. The panel then discussed the answers and the scores. “Before it was set in stone, anybody could go back and change their mark, because every single point was argued out,” says Rose.

She and Brian felt that some of the providers put too much emphasis on making cost savings, and therefore gave the highest rating to the provider that, she says, “sounded as if they cared more for the needs of the people they looked after”. The provider they helped choose, Affinity, took over one of five three-year contracts, worth a total of £15m, in April.

So, was it worth doing? Toby Staveley, the manager of Yellow Submarine, an Oxfordshire charity for people with learning disabilities, believes the principle of consultation with service users is “excellent”, but is disappointed that none of the providers chosen are local. “Local providers typically understand their audience better than a national provider,” he says. “By and large they will have trustees and staff who are local. They’ll bump into the same people they’re supporting in the supermarket, they’ll know their families, they’ll know their schools, and I think that’s lost with a national provider.”

From the council’s point of view, it has, says Terroni, been a “time-intensive” process but also “a really meaningful way of engaging service users from the word go to the final decision”. She says the response from service users and their families has been positive. It has certainly been a worthwhile experience for the Connollys. “Our peace of mind is dependent on Lynnie being in a secure environment,” says Brian. “Knowing that she is being cared for and looked after properly allows us to continue with our life in a fuller way, so being able to influence what’s going to happen was very cathartic for us.”